Compassionate health care was beneficial for patients through improving clinical outcomes, for health care systems by supporting financial sustainability and for health care professionals, through lowering burnout and promoting resilience and wellbeing, Caroline O’Regan, RCSI Graduate School of HealthCare Management told a meeting of HMI East. Maureen Browne reports.
Quoting the Dalai Lama, she said, “When we are motivated by compassion and wisdom, the results of our actions benefit everyone, not just our individual selves or some immediate convenience.”
Compassion, she said, could be defined as ‘a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it’ (Gilbert 2013). We could experience compassion in different ways – we could feel compassion for other people, we could experience compassion from others and there was also the compassion we could direct towards ourselves.
Research showed that compassionate leadership had wide-ranging benefits for both staff and organisations. People who worked in supportive teams with clear goals and good team leadership, had dramatically lower levels of stress (West et al 2015). Compassionate leadership increased staff engagement and satisfaction, resulting in better outcomes for organisations including improved financial performance (Dawson and West 2018). In NHS trusts, where staff reported the absence of such leadership, staff also reported higher levels of work overload and less influence over decision-making (West et al 2022) and organisations had poorer outcomes.
Ms. O’Regan looked at leading with Compassion versus leading with Compliance. She said leaders influenced culture, by what they attended to, what they valued, what they monitored and on what they modelled in their behaviours.
“Trzeciak and colleagues (2019) make a compelling case for ‘compassionomics,’ the knowledge and scientific study of the effects of compassionate health care. Their research review of hundreds of published studies shows that compassion is the most powerful intervention in health care, and that compassionate health care is beneficial for patients through improving clinical outcomes; for health care systems by supporting financial sustainability; and for health care professionals, through lowering burnout and promoting resilience and wellbeing.
“Compassionate leadership is not a ‘soft option’ and can help leaders effectively manage the performance of individuals, teams, organisations and systems (West 2021). Within health and care systems, too often performance problems are not directly addressed and so-called ‘wicked problems’ are avoided or hidden (Dixon-Woods et al 2014).”
“ There is clear evidence that compassionate leadership results in more engaged and motivated staff with high levels of wellbeing, which in turn results in high-quality care (West 2021).”
Ms. O’Regan said high quality patient care was linked to compassionate leadership, which was linked to lower stress and lower levels of harassment, better patient outcomes and overall performance. It had been shown that staff views of an organization equated to patients’ views of care quality. Staff satisfaction equated to patient satisfaction, high work pressure equated to less compassion, privacy and respect and poor staff well-being equated to poor performance. “Compassionate leadership and good PM practices account for 33% of hospital variance in mortality (ref Prof. West hhp:/www.dh.gov.uk/health/2011/nhs-staff management/www.nhsstaffsurveys.com)
“Meeting people’s core needs at work is important in supporting their wellbeing and motivation. Compassionate leaders constantly strive to understand and meet the core needs of the people with whom they work. Recent studies on doctors (West and Coia 2019) and nurses and midwives (West et al 2020), including those in training, have shown that the wellbeing, flourishing and work engagement of health and care staff, is affected by eight key factors that can be organised into three core needs. Meeting the core needs of staff can transform their work lives and in turn, the safety and quality of the care that they deliver.
“Core needs at work were (1) Autonomy (The need to have control over one’s work life and to be able to act consistently with one’s values), (2) Belonging (The need to be connected to, cared for by, and caring of, colleagues and to feel valued, respected and supported), (3) Contribution (The need to experience effectiveness in work ad deliver valued outcomes),
“Compassionate leaders focussed on four behaviours – (1) Attending (Paying attention to staff – ‘listening with fascination,’ (2) Understanding (Shared understanding of what they face, (3) Empathising (Caring for them) and (4) Helping taking intelligent action to serve or help.”
Ms. O’Regan said compassionate leaders focussed on enabling those they led to be effective and thrive in their work. They didn’t have all the answers and didn’t simply tell people what to do, instead they engaged with the people they worked with to find shared solutions to problems.
“For leadership to be compassionate, it must also be inclusive. Compassion blurs the boundaries between self and other, promoting belonging, trust, understanding, mutual support and, by definition, inclusion (West 2021). They develop “feedback” rich cultures and environments. This creates an inclusive, psychologically safe environment.”
Ms. O’Regan said psychological safety was vital for high performing teams. There needed to be a ‘shared understanding’ held by members of a team that the team is safe. The main characteristics of this was inclusivity, interpersonal trust and mutual respect. People should feel valued, belonging should be promoted and success celebrated. They should be comfortable being themselves and accept the future was uncertain. They should not fear they might be ridiculed, humiliated, or judged by colleagues.
High performing teams had a clear team identity, clear, agreed team objectives, team member role clarity, included in decision making, there should be effective intra and inter tam communication, constructive debate and effective inter-team working.
She said there were several factors could influence the capacity of people and teams to be compassionate, including poor working conditions, poor leadership, role confusion, role conflicts and excessive workload (Gilbert 2017; Cole-King and Gilbert 2011). One study had suggested that 56 per cent of health care providers didn’t think they had the time for compassion because they needed to focus on other tasks including administration, reducing costs and regulation (Reiss et al 2012)
She shared why it is imperative that people working in health and social care should practise self care. Leaders and teams need ‘protected time’ to allow rest and recharge. “Developing self-care to manage needs ensures you can be resourceful towards others. It is impossible to fully help others if your emotional and physical banks are empty. Great leaders nurture and role model self-care.
The COVID-19 pandemic put a strong spotlight on health care and the impact on health and care staff – this is still evolving but we know that staff in health and social care in Ireland – around the world – need time to heal, recover and renew. It is so important that Leaders and Managers pay special attention to protecting and supporting the well-being of themselves and the people who work in their organisation. This is challenging. Compassionate Leaders prioritise reflective time ensuring it is part of the culture that teams have protected time to meet and discuss “What is working, what’s not working, What do we need, What can we do about it, What next”?
This also applies to leader self-reflection, adopting Elizabeth Morris, the compassionate ambassador for Standford continually ask three simple questions, What am I feeling? What do I Need? What can I do about it?
Ms. O’Regan said we must have the courage of self-compassion. This involved R.A.I.N. – Recognising when we felt pain, Accepting the feelings rather than rejecting them , Inquiring into them with caring curiosity and Nurturing and caring deeply for ourselves.
Activities that aided recovery included psychological detachment from work, relaxation, achievement from carrying out a challenging tasks and control over what we did when in non-work time. “There are also some intuitive but empirically supported findings – Work breaks (e.g., proper lunch breaks without tasks), Vacations (though effects fade quickly), Physical activities/exercise, Natural environments, ‘Blue’ environments – sea, lakes, rivers etc., ‘Green’ environments – forests, hills, fields, Urban green (parks), Urban non-green (architectural variety and low building height). There was important ‘inverse recovery law’ – Those whose work was most stressful were least likely to do these things.